How accurate is preoperative colonoscopic localization of colonic neoplasia?

INTRODUCTION: Preoperative colonoscopic localization for resection of colonic neoplasia, with or without tattooing for guidance, has been extensively used with variable accuracy. Difficulty in intraoperative identification of the lesion may lead to resection of an incorrect segment or to a more extensive resection than originally planned. The aim of this study was to evaluate the accuracy of preoperative colonoscopy in determining the site of the lesion. METHODS: A prospectively collected IRB-approved institutional database was retrospectively queried for all consecutive patients who underwent an elective colon resection for neoplasia between 2013 and 2016. Excluded were patients without preoperative colonoscopy reports available for comparison or who underwent emergency surgery. Surgical plan based on preoperative colonoscopic localization with or without tattooing was compared to the final surgery and pathology reports. RESULTS: 203 patients were included [mean age 68 (35-92) years; 102 males (50.2%)]. Preoperative colonoscopy was inaccurate in 16.7% (34 patients) leading to a change in the surgical plan. Patients with transverse or distal lesions were more likely to have a change in final surgical management compared to proximal sided lesions (29.7% vs. 3.9%, respectively; p < 0.001). Only 3.8% of the tattooed lesions could not be identified during surgery. Additional intraoperative colonoscopy was needed in 11 patients (5.5%) to verify exact lesion location. Average length of the resected segment was longer in patients who required a change in surgical plan (26.44 cm vs. 22.47 cm; p = 0.02). CONCLUSION: Inaccurate preoperative colonoscopic localization led to a change in surgical management in 16.7% of cases, especially in transverse or left sided lesions. Surgeons should consider these findings when planning colonic resections.

Methylergometrine-Induced Myocardial Infarction in the Setting of a Cesarean Delivery.

A 30-year-old female with no significant past medical history presented to our labor and delivery ward for induction of labor. Due to failure to progress, she was proceeded to cesarean delivery. Intraoperatively, it was noted that her uterus was hypotonic; she required supplemental methylergometrine to control the bleeding from the uterine atony. However, within three minutes of intramuscular (IM) administration, she complained of chest pain. She then subsequently developed pulmonary edema in the postoperative care unit, which required supplemental oxygen. She was found to have elevated troponin and brain natriuretic peptide (BNP), along with radiologic features of fluid overload suggestive of congestive cardiac failure, which all lead to the diagnosis of non-ST myocardial infarction. The patient had a normal computed tomography (CT) pulmonary angiogram, echocardiogram, and serial electrocardiograms (ECGs). She was successfully discharged from the hospital on postoperative day 4 with resolution of her symptoms and improving cardiac enzymes. Cardiology outpatient follow-up was arranged.

Characteristics of Organ Donors Who Died From Suicide by Hanging in Australia and New Zealand: A Retrospective Study.

Background and objective The annual incidence of suicide by hanging in Australia and New Zealand has increased in the past decade, and a significant number of these individuals are becoming organ donors. The rates of organ donation following deaths from hanging is unknown and the characteristics of this cohort of donors have not been described in the literature. In light of this, we aimed to examine the trends in organ donation from individuals who had died from hanging, based on the solid organ donor data from the Australia and New Zealand Organ Donation (ANZOD) Registry. Methods We conducted a retrospective study that analyzed the ANZOD Registry donor data (2006-2015) to describe the characteristics of solid organ donors who had died by hanging (post-hanging group); these characteristics were compared to those of individuals who died by all other causes (non-hanging group). Results During the study period, the number and proportion of donors who died by suicide from hanging increased. Of the 4,024 consented organ donors, 226 had died by hanging and 3,798 had died from other causes. The probability that an individual who died by hanging would become an organ donor increased from 0.5 to 3%. Compared to donors who died by all other causes, post-hanging donors were younger (median age of 30 vs. 50 years), with fewer comorbidities, and a higher incidence of smoking. There was no significant difference in the proportion of those who indicated a prior intent to donate organs between post-hanging (34%) and non-hanging donors (38%). A higher proportion of post-hanging donors donated via the donation after the circulatory death pathway (36.3%) than non-hanging donors (24.2%). Individuals in the post-hanging cohort donated an average of 4.19 organs compared to 3.62 in the non-hanging cohort. Conclusion We believe the findings of this retrospective analysis will help inform clinical decision-making regarding organ donation, including the best approaches to obtaining donation consent. Our findings will help physicians provide care to patients and to families of individuals in this challenging group, where organ donation potential is high. Further investigations are required to determine which aspects of healthcare influence the donation rates in individuals who have died by hanging and the outcomes related to transplanted organs.